Basic Information
| Provider Information | |||||||||
| NPI: | 1295485167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOLIS RAMOS | ||||||||
| FirstName: | JAQUELYNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7017 S PRIEST DR APT 1086 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852836086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098564784 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1729 W GREENTREE DR STE 103 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852842712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026665101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2022 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | AZ | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.